| NPI | 1700357480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.2511824) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162800) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH CMS) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2025-01-22 |